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A_RN A_RN (New Member)

Post-Extubation Policy

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Hi,

I work in a small regional hospital and recently realized that our ICU has no policy for extubation or the immediate care after. I am trying to develop a policy of best practices so that I can develop one.

I am just wondering if anyone would be willing to share policies from their facilities?

Thanks,

AG

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Where I work we put them on pressure support, make sure their tidal volumes are good and they are alert enough to follow commands for at least 4 hours or so (depends on patient condition and length of intubation). If the MDs give the go ahead to extubate then we call respiratory therapy and we check for a cuff leak and then extubate to 40% ventimask and leave them on that for about 2 hours. If they are doing well after 2 hours then we move them to nasal cannula and also start dysphagia screening with ice unless there are contraindications.

Also, do not forget to consider whether you will leave the NGT in or take it out? If you think the patient will fail swallowing then leave it in so you will not need to put another one in. Neuro patients and the elderly may need more time to regain swallowing abilities and may need tube feeds/meds but are okay to be extubated.

Edited by KeepinitrealCCRN
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Similar to the above post, we stop sedation and check alertness and command following and put them on spontaneous/pressure support for at least an hour. Sometimes an hour is all an agitated, non-sedated patient who's eager to get the tube out can stand, but usually we go longer if tolerated. Then RT does a few tests involving NIF, tidal volumes, cuff leak, etc. Then if physician is okay with it we go ahead and extubate. We will go straight to nasal cannula and increase oxygen delivery if need be.

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